Emergency Medical Procedures: Case Study and Questions for Healthcare Professionals, Exams of Nursing

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RQI 2025 ACLS HEALTHCARE PROVIDER

Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of myocardial ischemia, what will your first actions include (if not completed by EMS before arrival)? o Obtain a 12-lead electrocardiogram (ECG) o Administer a blood thinner o Administer aspirin and establish IV access o Activate the ST-segment elevation myocardial infarction (STEMI) team o If SPO2 is less than 90%, start oxygen o Assess airway, breathing, and circulation (ABCs) o Administer epinephrine 1 mg IV o Consider nitroglycerin, morphine and a P2Y inhibitor - Answers - o Obtain a 12-lead electrocardiogram (ECG) o Administer aspirin and establish IV access o Activate the ST-segment elevation myocardial infarction (STEMI) team o If SPO2 is less than 90%, start oxygen o Assess airway, breathing, and circulation (ABCs) o Consider nitroglycerin, morphine and a P2Y inhibitor His initial vital signs are HR 120/min, BP 135/88 mm Hg, RR 23/min, SpO2 87%, and temperature 37.3C. When considering oxygen saturation, what is your course of action? o Intubate the patient immediately o Administer albuterol nebulizer o Do not start oxygen o Start oxygen at 4L/min via nasal cannula - Answers - o Start oxygen at 4L/min via nasal cannula What additional question help you determine next steps? o Do you take any medication? o Do you have any allergies? o When was the last time you went to the doctor? o When did the symptoms start? o Have you had any recent falls? - Answers - o Do you take any medication? o Do you have any allergies? o When did the symptoms start? Your patient continues to say that he has chest discomfort. What treatment can you repeat as long as it is not contradicted by vital signs? o Morphine sublingual every 1 to 3 minutes o Morphine IV every 1 to 3 minutes o Nitroglycerine sublingual or translingual every 3 to 5 minutes o Nitroglycerine every 1 to 3 minutes - Answers - o Nitroglycerine sublingual or translingual every 3 to 5 minutes

What is your interpretation of the patient's ECG tracing? o Anterior ST-segment elevation of myocardial infarction (STEMI) o Ventricular tachycardia o Posterior ST-segment elevation myocardial infarction (STEMI) o Normal sinus rhythm with premature ventricular contractions - Answers - o Anterior ST-segment elevation of myocardial infarction (STEMI) With the diagnosis of STEMI, what is the most probable treatment? o Release to home o Admission to an intensive car unit o Admission for observation o Admission for PCI or fibrinolysis - Answers - o Admission for PCI or fibrinolysis What is your goal for PCI when treating this patient? o Door-to-balloon inflation time of 30 minutes o First medical contact-to-balloon inflation time of 90 minutes o Door-to-needle time of 90 minutes o First medical contact-to-needle time of 30 minutes - Answers - o First medical contact- to-balloon inflation time of 90 minutes The patient's vital signs show HR 92/min, RR 14/min, BP 130/86 mm Hg, SpO2 97%, and atrial fibrillation on the monitor. What additional assessment and stabilization activities should be completed with the first 10 minutes after the patient's arrival? o Establish IV access o Order an emergent CT scan or MRI of the brain and review patient history o Monitor for worsening symptoms o Activate the stroke team o Complete neurologic screening o Check glucose o Administer O2 - Answers - o Establish IV access o Order an emergent CT scan or MRI of the brain and review patient history o Activate the stroke team o Complete neurologic screening o Check glucose What needs to be completed for this patient within 20 minutes after hospital arrival? o Neurologic assessment o Admission to a monitored bed o Interpretation of the emergent CT scan or MRI of the brain o Administration of fibrinolytic therapy - Answers - o Neurologic assessment As part of the neurologic assessment, you perform a physical and neurologic examination. What are some of the general questions you need to ask? o What other symptoms do you have? o Has your wife been sick as well? o Do you take any medications?

Based on the patient's condition, what is your next action? o Pause CPR to establish IV/IO access o Continue CPR while you establish IV/IO access o Shock immediately o Continue CPR while delivering shock - Answers - o Shock immediately After a shock is delivered, CPR resumes immediately. What actions also needs to be performed at this time? o Establish IV/IO access o Administer amiodarone or lidocaine o Consider an advanced airway o Perform a second rhythm check - Answers - o Establish IV/IO access After 2 minutes, the team pauses CPR for a rhythm check. What rhythm is now being demonstrated by the patient? o Ventricular tachycardia o Pulseless electric activity o Ventricular fibrillation o Asystole - Answers - o Ventricular tachycardia The patient is showing persistent pulseless ventricular tachycardia. What actions need to be completed next by the team? Place in the correct order o Shock immediately o Resume CPR o Administer epinephrine 1mg IV o Consider an advanced airway - Answers - o Shock immediately o Resume CPR o Administer epinephrine 1mg IV o Consider an advanced airway At the next pulse check, compressors are switched, and rhythm continues to be refractory ventricular fibrillation/ventricular tachycardia. A shock is delivered and CPR is resumed. What is your next intervention? o Administer amiodarone 300mg IV o Administer procainamide 15 to 18 mg/kg IV loading dose o Administer epinephrine 1mg IV - Answers - o Administer amiodarone 300mg IV After 2 more minutes of CPR, you conduct a rhythm check and a pulse check, confirming absence of a pulse. Based on the organized rhythm below, describe the patient's condition? o Normal sinus rhythm o Pulseless electrical activity o Sinus bradycardia o Junctional rhythm - Answers - o Pulseless electrical activity

Once PEA is identified and there are no signs of ROSC, you continue CPR. What is your next step for appropriate care for this patient? o Administer epinephrine 1mg IV o Administer amiodarone 150mg IV o Administer amiodarone 300mg IV o Administer epinephrine 1.5mg IV - Answers - o Administer epinephrine 1mg IV After 2 minutes of CPR, you conduct another rhythm check and determine that the patient has the following rhythm and is showing signs of ROSC. How do you continue treating this patient? o Administer another dose of 1mg of epinephrine o Move to the Adult Post-Cardiac Arrest Care Algorithm o Resume CPR and repeat the steps of the PEA pathway o Pause CPR and consider an advanced airway - Answers - o Move to the Adult Post- Cardiac Arrest Care Algorithm She has a palpable pulse, HR of 65/min, SpO2 of 94%, ETCO2 of 38 mm Hg, and BP 82/55 mm Hg. What are your highest priorities? Select all that apply. o Maintaining a target PaCO2 between 45 and 55 mm Hg o Maintaining SpO2 92% to 98% o Hyperventilation o Ventilating the patient with 10 breaths per minute o Maintaining a target PaCO2 between 35 and 45 mm Hg - Answers - o Maintaining SpO2 92% to 98% o Ventilating the patient with 10 breaths per minute o Maintaining a target PaCO2 between 35 and 45 mm Hg You obtain a 12-lead ECG. What is the most appropriate action to take next? o Observe the patient o Transfer the patient to an intensive care unit o Discharge the patient and have her follow-up with her primary care provider o Transfer the patient to a cardiac-cath lab for percutaneous coronary intervention - Answers - o Transfer the patient to a cardiac-cath lab for percutaneous coronary intervention In addition to managing the airway and respiratory parameters, which step is also prioritized during the initial stabilization phase? o Initiating targeted temperature management o Administering alteplase o Performing percutaneous coronary intervention o Treating hypotension - Answers - o Treating hypotension Match the treatment for hypotension to the proper initial dosage for an adult based on the AHA guidelines. o Dopamine IV 5 to 20 mcg/kg per minute o Normal saline or lactated Ringer's to 2L